First Amendment — Redondo Beach City Council, January 17, 2023

FIRST AMENDMENT TO SUPPORT SERVICES AGREEMENT

BETWEEN UAS AIR AND CITY OF REDONDO BEACH
THIS FIRST AMENDMENT TO THE SUPPORT SERVICES AGREEMENT (this "First Amendment") is made between the City of Redondo Beach, a Chartered Municipal Corporation (City") and Flying Lion, Inc., a California Corporation ("Contractor" or "Consultant")
WHEREAS, the parties hereto entered into that certain Project Services Agreement between City and Contractor (the "Agreement") on April 2, 2019; and WHEREAS, the parties wish to amend the agreement to: (1) clarify the scope of services provided by Contractor, (2) extend the term of the Agreement until February 15, 2022 and (3) modify Exhibit "C" to include updated UAS rental and service rates.

NOW, THEREFORE, the parties hereby agree to amend the Agreement as follows:

1. Exhibit "A" shall be deleted in its entirety and replaced with Exhibit "A-1" which is attached hereto and incorporated by reference.

2. Exhibit "A-1" shall be re-named Exhibit "A-2" but shall remain otherwise unchanged.

3. Exhibit "B" shall be deleted in its entirety and replaced with Exhibit "B-1" which is attached hereto and incorporated by reference.

4. Exhibit "C" shall be deleted in its entirety and replaced with Exhibit "C-1" which is attached hereto and incorporated by reference. Consultant shall be compensated for the services described in Exhibit "A-1" of this First Amendment in accordance with Exhibit "C-1".

5. NO OTHER AMENDMENTS. Except as expressly stated herein, the Agreement shall remain unchanged and in full force and effect. The Agreement and this First Amendment constitute the entire agreement between the parties and supersede any previous oral or written agreement with respect to the subject matter hereof. • In the event of any inconsistency between the terms of the Agreement, and this First Amendment, the terms of this First Amendment shall prevail.

SIGNATURES FOLLOW ON NEXT PAGE
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IN WITNESS WHEREOF, the parties hereby have executed this First Amendment as of this 9th day of March, 2021.

CITY OF REDONDO BEACH FLYING LION, INC.

By:

William C. Brand, Mayo Name: J- BROLNAN
Title: PRESIDENT
ATTEST:

Chann Hereans
Eleanor Manzano, City Clerk)
Diane Strickfaden, Risk Manager
APPROVED AS TO FORM:

Mal w. well
Michael W. Webb, City Attorney

UPDATED EXHIBITS FOLLOW
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EXHIBIT "A-1"

PROJECT DESCRIPTION AND/OR SCOPE OF SERVICES
A. SCOPE
City Location: Within the boundaries of the City of Redondo Beach, California and neighboring cities as may be required in the performance of duties pursuant to this Agreement.

Description of Service: Unmanned Aerial Support (UAS) with Unmanned Aerial Vehicles (UAVs)
B. CONTRACTOR'S DUTIES
Contractor shall perform the following duties.

Implement and administer the UAS program that utilizes UAVs to provide Air Support Services to enhance the department's mission of protecting lives and property. This includes, Drones as a First Responder (DFR), On-demand UAS services, equipment leasing, and maintenance.

2. For On-Demand UAS services, Contractor will provide all tools and equipment necessary to perform duties described herein which are included in pricing. For DFR program if City uses City owned drones, there will be no hourly drone rental fee as listed in Exhibit "C-1"
For On-Demand UAS services, Contractor shall provide an after-action report after each UAS deployment within 72 hours of such deployment. The report shall provide a summary of the deployment including duration and approximate location of use as well as the results of such deployment.

4. Contractor shall obtain prior approval of Redondo Beach Police Department watch commander in order to deploy UAS pursuant to this Agreement.

Contractor shall utilize drones of the quality listed in Exhibit "A-2" or better while performing duties as directed by City pursuant to this Agreement.

Contractor shall provide to City at least two (2) UAS to City which are housed at the Redondo Beach Police Station and available for use by trained City personnel on an as needed basis.
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C. CITY'S DUTIES
City shall provide direction to Contractor with regard to the use of UAV's pursuant to this Agreement.

City shall provide insurance for all department owned aircraft.

For DFR operations, City will help secure rooftop access, provide rooftop wired high-speed internet access, and cover the cost for Motorola Solutions Aerial Suite and/or any other systems/software necessary for DFR program operations.
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EXHIBIT "B-1"
TERM
TERM. The term of this Agreement shall commence February 12, 2021 and expire February 11, 2022 ("Term"), and will automatically renew for (1) additional twelve-month term (a "Renewal Term"), unless otherwise terminated as herein provided. Any additional Renewal Terms) to this Agreement shall be in writing, executed by both parties
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EXHIBIT "C-1"

COMPENSATION
A. AMOUNT
Contractor shall provide services as described in this First Amendment at the rates provided below. The total not to exceed amount for this First Amendment is $105,080.

DER Program (minimum of 40 hours per week)
a. DR Daylight Operations RPIC $40.44/hour 30 minutes after sunrise to 30 before sunset
DFR Nighttime Operations RPIC $45.99/hour 30 minutes before Sunset to 30 minutes after sunrise
DFR non-fly day rate due to weather, TFR, etc. $28.00/hour (minimum of 5 hours per day guaranteed)
d. DFR Visual Observer (VO) for Night Operations $25.00/hour DFR Management Fee $15.00/hour (for non - FAA Part 107
certified Air Support Officer
f. DFR Drone equipment rental fee $10.00/hour (if drone is not supplied by city)
On-demand Program
a. Call out Flying Hourly Rate -$300.00/hour
b. Minimum Call-out Charge -$600.00 (two (2) hours)
Consulting/Training
Consulting Rate $200.00/hour
Training Rate (up to 10 students) $1000.00/day Part 107 Exam (3 days)
Flight Training (2 days) Motorola Aerial (1 day)
Equioment Purchase/Lease/Maintenance
a. UAS Equipment Leasing (Mavic Pro "Go Boxes" UAS)
$195.00/month per UAS
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b. UAS Equipment Maintenance $200 per month
C. Equipment Leasing Varies dependent on equipment
d. Equipment Maintenance Varies dependent on equipment
Miscellaneous
- Any additional services provided by Flying Lion, Inc. shall be provided at current Rates as described above.

B. METHOD OF PAYMENT. Contractor shall provide a monthly invoice to City for approval and payment. Invoices must be itemized, adequately detailed, based on accurate records, and in a form reasonably satisfactory to City. Contractor may be required to provide back-up documentation upon request.

C. SCHEDULE OF PAYMENT. City agrees to pay Contactor within thirty (30) days of receipt of the invoice; provided, however, that services are completed to the City's full satisfaction.

D. NOTICE. Written notices to City and Contractor shall be given by register or certified mail, postage prepaid and addressed to or personally served on the following parties:

Contractor: Flying Lion, Inc.
2110 Artesia Blvd., Suite 234 Redondo
Beach, CA 90278
City: Redondo Beach Police Department 401
Diamond Street
Redondo Beach, CA 90277
All notices, including notices of address changes, provided under this Agreement are deemed received on the third day after mailing if sent by registered or certified mail.

Changes in the respective address set forth above may be made from time to time by any party upon written notice to the other party
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DATE (IMODYYYY)

ACORD CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR MEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUNG INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: i the certificate holder is an ADDITIONAL INSURED. the policy(ies) must have ADDITIOKAL INSURED provisions or be endorsed I SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements).

Lin D Diaz
FAX
D&C Insurance Solutions SAC.M. Ert: 888.457.4426 323 576.4552 SEAL
ADORES: contact@@dcwnsurance.com
30D S. Adantic Blwd., Ste 201-8 INSURER|E) AFFORDMO COVERAGE MASC S CA 91754 INSURERA: Western World Insurance Company 13198 Monterey Park
INSURED MSURER B:

Tillmann Forensic Investigations, LLC. MAURER C:

INSURER D:

PO Box 4373 INSURER E:

Covina CA 91723 NEURER F:

COVERAGES CERTIFICATE NUMBER: REVISION MUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

MIR
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COMMERCIAL GENERAL LIABILITY NPP8622748 12/17/2020 | 12/17/2021 EACH OCCURRENCE DANAGE TO RENTEO 100.000
CLAME MADE OCCUR PREMBER ED OCCUTEnCE:

MED EXP My one person: 5.00Đ
PERBONAL & ADV AUURY 1,000,000
GENERAL AGGREGATE 2.000,000
GENT AGGREGATE LIMIT APPLIES PER:

PRODUCTE - COMFIOP AGG included

X FOLICY SECT LOC
Errors & Omissions Included

OTHER COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY LEd accident!
ANY ALTO BOOLY IAJURY iPer person:

OWNED SCHEDULED BOCLY INJURY (Per accidenti

AUTOG ONLY AUTOS

NON-OWNED PROPERTY DAMAGE
MRE iPer scoldertl

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UMBRELLA LIAB OCCUR EACH OCCURRENCE

EXCESS LIAB AGGREGATE

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WORKERS COMPENBATION STATUTE |
AND EMPLOYER&' LIABILITY YiN
• E.L. EACH ACCIDENT
EL. DISEASE - EA EMPLOYEE S
me describe u E.L. DISEASE - POLICY LMIT |
SCRIPTION OF OPERATIONS bec
DESCRIPTION OF OPERATIONE / LOCATIONS / VEHICLE LACORD 101, Addisonal Romants Saladule, may be attached if man spece is rome! Regarding the above referenced General Liability Insurance policy, the certificate holder is included as additional insured. but only with respect to the negligent acts, errors or omissions of the named insured

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Redondo Beach THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELVERED 1! 401 Diamond Street ACCORDANCE WITH THE POLICY PROVISIONS.

Redondo Beach, CA 90277

AUTHORIZED REPRERENTATIVE
Lin Dau Diaz
© 1988-2015 ACORD CORPORATION. All rights reserved.

ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD

CERTIFICATE OF INSURANCE
This certificate is given as a matter of information only and confers no rights upon the certificate addressee.

Date: February 05, 2021
That the following policy has been issued to:

WWW.FLYINGLIONINC.COM
2110 ARTESIA BLVD. SUITE 234
UNIT B
REDONDO BEACH, CA 90278
Policy No. 9023167 issued by one or more member companies of Global Acrospace Pool through Global Aerospace, Inc.

Policy Period: Irom March 21, 202010 March 21, 2021 Policy Terriory. Worldwide

AIRCRAFT AND COMMERCIAL GENERAL AVIATION LIABILITY
Single Limit Bodily Injury and Property Damag
All expressed limits are "Each Occurrence" unless otherwise indicated Registration Number Year, Make & Model Liability Limit Third Party War Liability 095XFBH00201N5 2018 DJI INNOVATIONS MATRICE 210 $2,000,000 $2,000,000 Aggregate 298DG13001PXD8 2018 DJI INNOVATIONS MAVIC 2 ENTERPRISE DUAL $2,000,000 $2,000,000 Aggregale Policy includes Commercial General Aviation Liability coverages, with limits as shown in the policy.

Solely as respects an occurrence arising out of the ownership. maintenance or use of an unmanned aircraft insured under this policy and solely to the extent required in an agreement with the Named Insured, the following provisions shall apply:

The WHO IS AN INSURED section of the policy is amended to include the certificate addressee as an insured. but only as respects the Named Insured's use of the aircraft and only with respect to the certificate addressee's liability because of acts or omissions of the Named Insured. However, o such person or organization is an Insured if he, she. or it, or any of his, her. or its agents or employees is engaged in the manufacture, maintenance epair, or sale of aircraft, aircraft engines, components or accessories, or in the operation of any airport, hangar, flying school, flight service, or aircra or piloting service, as respects any occurrence arising out of such activity.

The insurance, as to the interest of the certificate addressee, shall be primary without right of contribution by any other valid and collectible insurance available to the certificate addressee.

We waive any right of recovery we may have against the certificate addressee because of payments it makes for physical damage to aircraft described in this certificate. but only to the same extent that the Named Insured has waived its right for recovery for such physical damage against the certificate addressee.

If the certificate addressee information shown on this certificate includes a valid mailing address, we agree to give 30 days (10 if cancelled for non- payment of premium) notice to the certificate addressee in the event the policy is cancelled or materially changed by us.

Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may perrain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. This certificate does not amend, exten or otherwise alter the coverages afforded by the policies described herein. Limits may have heen reduced by paid claims GLOBAL AEROSPACE, INC. GLOBAL AEROSPACE
BY:

AC7001 (September I, 2009) Page 1 of 1 Certificate No. ACZ0100014658 Liberty
Mutual.

INSURANCE Policyholder Information
Named Insured & Mailing Address Agent Mailing Address & Phone No.

FLYING LION, INC (812) 547-7901
2110 ARTESIA BLVD STE 234 HARPENAU INSURANCE, INC
REDONDO BEACH, CA 90278 PO BOX 7
TROY, IN 47588-0007
.95862.9 Dear Policyholder:

We know you work hard to build your business. We work together with your agent, NOT A Your HARPENAU INSURANCE, INC (812) 547-7901
Commercial to help protect the things you care about. Thank you for selecting us. 315000 Documents
Enclosed are your insurance documents consisting of:
• Workers Compensation And Employers Liability Insurance Policy, Information Page, Endorsements and Other Documents To find your specific coverages, limits of liability and premium, please refer to your Workers Compensation and Employers Liability Insurance Policy Information Page, extensions, the policy and endorsements.

If you have any questions or changes that may affect your insurance needs, please contact your Agent at (812) 547-7901
Verify that all information is correct
• If you have any changes, please contact your
Agent at (812) 547-7901
Reminders In case of a claim, call your Agent or 1-844-325-2467 You Need To Know
• CONTINUED ON NEXT PAGE
To report a claim, call your Agent or 1-844-325-2467
DS 70 20 01 08
You Need To Know - continued
• NOTICE(S) TO POLICYHOLDER(S)
The Important Notice(s) to Policyholder(s) provide a general explanation of changes in coverage to your policy. The Important Notice(s) to Policyholder(s) is not a part of your insurance policy and it does not alter policy provisions or conditions. Only the provisions of your policy determine the scope of your insurance protection. It is important that you read your policy carefully to determine your rights, duties and what is and is not covered.

FORM NUMBER TITLE
CNI90 11 07 18 Reporting A Commercial Claim 24 Hours A Day NP 74 44 09 06 U.S. Treasury Department's Office of Foreign Assets Control (OFAC) Advisory Notice to Policyholders
NP 91 89 02 13 Important Information Consumer Affairs Policyholder Notice NP 91 91 02 13 Important Policyholder Information Concerning Billing Practices - Califomia PN 04 99 01 G Policyholder Notice -Your Right To Rating and Dividend Information PN 04 99 02 B Policyholder Notice California Workers' Compensation Insurance Rating Laws PN 04 99 04 California Insurance Guarantee Association (CIGA) Surcharge SNW04 08 07 18 Policyholder Notice - California Assembly Bill (AB) 2883 and Senate Bill (SB) 189
SNW04 11 04 18 California Risk Control Services
SNW04 13 01 18 Policyholder Notice California Senate Bill (SB) 1160 - Managed Care Notification SNW04 14 01 20 Liberty Mutual Privacy Notice - California • This Workers Compensation and Employees Liability policy is auditable. Please refer to the conditions of the policy for details or contact your agent.
• This policy will be direct billed. You may choose to combine any number of policies on one bill with your billing account. Please contact your agent for more information. of 54
CNI 90 11 07 18
REPORTING A COMMERCIAL CLAIM 24 HOURS A DAY
Liberty Mutual Insurance claims professionals across the United States are ready to resolve your claim quickly and fairly, so you and your team can focus on your business. Our claims teams are specialized, experienced and dedicated to a high standard of service.

We're Just a Call Away - One Phone Number to Report All Commercial Insurance Claims Reporting a new claim has never been easier. A Liberty Mutual customer service representative is available to you 24/7 at 1(844) 325-2467 for reporting new property, auto, liability and workers' claims. With contact centers strategically located throughout the country for continuity and accessibility, we're there when we're needed!
Additional Resource for Workers' Compensation Customers 61298567
website along with other helpful resources such as:
• Direct links to state workers compensation websites where you can find state-specific claim 103518
• Assistance finding local medical providers
irst Fill pharmacy forms - par of our managed care pharmacy program committed to helping jured workers recover and return to wor
Our Policyholder Toolkit can be accessed at www.libertymutualgroup.com/toolkit.

For all claims inquiries please call us at
@ 2018 Liberty Mutual Insurance
CNI 90 11 07 18 Page 1 of 1
NP 74 44 09 06
U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN
ASSETS CONTROL ("OFAC")

ADVISORY NOTICE TO POLICYHOLDERS
No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided.

This Notice provides information concerning possible impact on your insurance coverage due to directives issued by OFAC. Please read this Notice carefully.

Please refer any questions you may have to your insurance agent.

The Office of Foreign Assets Control (FAC) administers and enforces sanctions policy, based on Presiden- tial declarations of "national emergency". OFAC has identified and listed numerous:
• Foreign agents;
• Front organizations;
• Terrorists;
• Terrorist organizations; and
• Narcotics traffickers;
as Sury website ate aires gandocked Persons". This list can be located on the United States accordance with OFAC regulations. if it is determined that vou or any other insured, or any person o ntity claiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designate National and Blocked Person, as identified by OFAC, this insurance will be considered a blocked or frozen contract and all provisions of this insurance are immediately subject to OFAC. When an insurance policy is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments also apply. © 2011 Liberty Mutual Insurance. All rights reserved.

NP 74 44 09 06 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 NP 91 89 02 13

IMPORTANT INFORMATION
Consumer Affairs - California
Because of the complicated nature of the insurance business, there may be times when you will have questions regarding your coverage or the premium charged, or a problem may occur with your policy. If this occurs we urge you to contact either your agent or broker to answer your question or resolve your problem.

However, if you are unable to receive a satisfactory answer or resolution to your problem, please contact us directly:

American Fire and Casualty Company
Chio Security Insurance Company
The Ohio Casualty Insurance Company
61298567 West American Insurance Company
1-800-688-8661
If you are still not satisfied, you may contact the following State Agency:
003518
California Department of Insurance
300 South Spring Street
Los Angeles, CA 90013
Toll Free Number: 1-800-927-HELP (Calif. only)
NP 91 89 02 13 2013 Liberty Mutual Insurance Page 1 of 1 NP 91 91 02 13

IMPORTANT POLICYHOLDER INFORMATION

CONCERNING BILLING PRACTICES - CALIFORNIA
Dear Valued Policyholder: This insert provides you with important information about our policy billing practices that may affect you. Please review it carefully and contact your agent if you have any questions.

Premium Notice: We will mail you a policy Premium Notice separately. The Premium Notice will provide you with specifics regarding your agent, the account and policy billed, the billing company, payment plan, policy number, transaction dates, description of transactions, charges/credits, policy amount balance, mini- mum amount. and payment due date. This insert explains fees that may apply to and be shown on your Premium Notice.

Available Premium Payment Plans:
• Annual Payment Plan: When this plan applies, you have elected to pay the entire premium amount balance shown on your Premium Notice in full. No installment billing fee applies when the Annual Payment Plan applies.

Installment Payment Plan: When this plan applies, you have elected to pay your policy premium in installments (e.g.: quarterly or monthly installments - Installment Payment Plans vary by state). As noted below, an installment fee may apply when the Instailment Payment Plan applies.

The Premium Payment Plan that applies to your policy is shown on the top of your Premium Notice. Please contact your agent if you want to change your Payment Plan election.

Installment Payment Plan Fee: If you elected to pay your premiums in installments using the Installment Premium Payment Plan, an installment billing fee applies to each installment bill. The installment billing charge will not apply, however, if you pay the entire balance due when you receive the bill for the first installment. Because the amount of the installment charge varies from state to state, please consult your may refuse to honor the premium payment withdrawal
request you submit to us due to insufficient funds in your account or for some other reason. If that is the case, and your premium payment withdrawal request is returned to us dishonored, a payment return fee will apply. Because the amount of the return fee varies from state to state, please consult your Premium Notice for the actual fee that applies.

Late Payment Fee: If we do not receive the minimum amount due on or before the date or time the payment is due, as indicated on your Premium Notice, you will receive a policy cancellation notice effective at a future date that will also reflect a late payment fee charge. Issuance of the cancellation notice due to non-payment of a scheduled installments) may result in the billing and collection of all or part of any outstanding premiums due for the policy period. Late Payment Fees vary from state to state and are not applicable in some states.

Special Note: Please note that some states do not permit the charging of certain fees. Therefore, if your state does not allow the charging of an Installment Payment Plan, Dishonored Payment or Late Payment Fee, the disallowed fee will not be charged and will not be included on your Premium Notice.

EFT-Automatic Withdrawals Payment Option: When you select this option, you will not be sent Premium Notices and, in most cases, will not be charged installment fees. For more information on our EFT-Auto- matic Withdrawals payment option, refer to the attached policyholder plan notice and enrollment sheet.

Schedule of Fees
Type of Fee Fee Amount
Installment Payment Plan Non Recurring Payment Option $10.00 EFT-Automatic Withdrawals Payment Option $0.00
Dishonored Payment $20.00
Late Payment $25.00
Once again, please contact your agent if you have any questions about the above billing practice informa- Thank you for selecting us to service your insurance needs.

NP 91 91 02 13 © 2013 Liberty Mutual Insurance Page 1 of 1 PN 04 99 01 G
(Ed. 03-19)

POLICYHOLDER NOTICE

YOUR RIGHT TO RATING AND DIVIDEND INFORMATION
I. Information Available to You
A. Information Available from Us - Ohio Security
(1) General questions regarding your policy should be directed to:

Liberty Mutual Insurance
Attn Corporate Underwriting
61298567
(2) Dividend Calculation. If this is a participating policy (a policy on which a dividend may be paid, upon payment or non-payment of a dividend, we shall provide a written explanation to sets forth the basis of the dividend calculation. The explanation 03512 of the earned premium for the policy year on which the dividend is calculated (3) Claims Information. Pursuant to Sections 3761 and 3762 of the California Labor Code, you are entitled to receive information in our claim files that affects your premium. Copies of docu- ments will be supplied at your expense during reasonable business hours. estimates to the Workers' Compensation Insurance Rating Bureau of California (WCIRB) no later than twenty months after the policy becomes effective. The cost of any settled claims will also be reported at that time. At twelve-month intervals thereafter, we will update and report to the WCIRB the estimated cost of any unsettled claims and the actual final cost of any claims settled in the interim. The amounts we report will be used by the WIRB to compute your experience modification if you are eligible for experience rating B. Information Available from the Workers' Compensation Insurance Rating Bureau of California (1) The WCIRB is a licensed rating organization and the California Insurance Commissioner's designated statistical agent. As such, the WCIRB is responsible for administering the California Workers' Compensation Uniform Statistical Reporting Plan-1995 (USRP) and the California Workers' Compensation Experience Rating Plan-1995 (ERP). WCIRB contact information is: WCIRB, 1221 888.229.2472 (phone);
Broadway.
415.778.7272 (fax); and [email protected] (email). The regulations contained in the USRP and ERPare available for public viewing through the WIRB's website at woirb.com.

Policyholder Information. Pursuant to California Insurance Code (CIC) Section 11752.6, upon written request, you are entitled to information relating to loss experience, claims, classifica - tion assignments, and policy contracts as well as rating plans, rating systems, manual rules, or other information impacting your premium that is maintained in the records of the WIRB and Requests for Action requesting policyholder information should be forwarded to: WCIRB, 1221 Broadway. Suite 900, Oakland, CA 94612, Attn: Custodian of Records. The Custodian of Records can be reached at 415.777.0777 (phone) and 415.778.7272 (fax).

Experience Rating Form. Each experience rated risk may receive a single copy of its current free of charge by completing a Policyholder Experience
Rating Worksheet Request Form on the WCIRB's website at wcirb.com/ratesheet. The Exper- ience Rating Form/Worksheet will include a Loss- Free Rating, which is the experience modi- fication that would have been calculated if $0 (zero) actual losses were incurred during the experience period. This hypothetical rating calculation is provided for informational purposes only.
© 2019 Workers' Compensation Insurance Rating Page 1 of 3 PN 04 99 01 G
(Ed. 03-19) Bureau of California. All Rights Reserved
Il. Dispute Process
You may dispute our actions or the actions of the WIRB pursuant to CIC Sections 11737 and 11753.1.

A. Our Dispute Resolution Process.

If you are aggrieved by our decision adopting a change in a classification assignment that results in increased premium, or by the application of our rating system to your workers' compensation insurance, you may dispute these matters with us. If you are dissatisfied with the outcome of the initial dispute with us, you may send us a written Complaint and Request for Action as outlined You may send us a written Complaint and Request for Action requesting that we reconsider a change in a classification assignment that results in an increased premium and/or requesting that we review the manner in which our rating system has been applied in connection with the insur- ance afforded or offered you. Written Complaints and Requests for Action should be forwarded to:

Liberty Mutual Insurance, Attn Corporate Underwriting, 1615 Murray Canyon Road, Suite 300, San Diego, CA 92108, (Telephone) 619-744-6000.

After you send your Complaint and Request for Action, we have 30 days to send you a written notice indicating whether or not your written request will be reviewed. If we agree to review your request, we must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If we decline to review your request, if you are dissatisfied with the decision upon review, or if we fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph 1l.C., below.

B. Disputing the Actions of the WIRB. If you have been aggrieved by any decision, action, or omis- which its rating system has been applied in connection with the insurance afforded or offered you.

For requests related to classification disputes, the reporting of experience, or coverage issues, your initial request for review must be received by the WIRB within 12 months after the expiration date of the policy to which the request for review pertains, except if the request involves the application of the Revision of Losses
request for review must be received by the WIRB within 6 months after the issuance, or 12 months after the expiration date, of the experience modification to which the request for review pertains, whichever is later, except if the request for review involves the application of the Revision of Losses rule. If the request involves the Revision of Losses rule, the time to state your appeal may be longer. (See Section VI, Rule 7 of the ERP).

You may commence the review process by sending the WIRB a written Inquiry. Written Inquiries should be sent to: WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attr: Customer Service Customer be reached at 888.229.2472 (phone), 415.778.7272 (fax) and [email protected] (email).
within 90 days after receipt of the Inquiry, you may pursue the subject of the Inquiry by sending the Action, the WCIRB has 30 days to send you written notice indicating whether or not your written and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If the WIRB declines to review your request, if you are dissatisfied with the decision upon review, or if the WIRB fails to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph Il.C., below Written Complaints and Requests for Action should be forwarded to: WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attn: Complaints and Reconsideration. The WIRB's contact information is 888.229.2472 (phone), 415.371.5204 (fax) and [email protected] (email).

C. California Department of Insurance - Appeas to the Insurance Commissioner. After you follow the appropriate dispute resolution process described above, if (1) we or the WIRB decline to review your request, (2) you are dissatisfied with the decision upon review, or (3) we or the WCIRB fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner pursuant to CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of Section 2509.40 et seq. You must file your appeal within 30 days after we or the WCIRB send you the notice rejecting review of your Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no written decision regarding your Com- plaint and Request for Action is sent, your appeal must be filed within 120 days after you sent your Complaint and Request for Action to us or to the WIRB. The filing address for all appeals to the Insurance Commissioner is:

Administrative Hearing Bureau
California Department of Insurance
45 Fremont Street, 22nd Floor
San Francisco, CA 94105
61298567 415.538.4102
Vou Rave the beat to a eating be or the insurance Commisioner, and our action, or the acin of the IlI. Resources Available to You in Obtaining Information and Pursuing Disputes A. Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder ombudsman is available at the WIRB to assist you in obtaining and evaluating the rating, policy. and claims information referenced in I.A. and I.B., above. The ombudsman may advise you on any dispute with us, the WIRB, or on an appeal to the Insurance Commissioner pursuant to Section 11737 of the Insurance Code. The address of the policyholder is WIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attn: Policyholder Ombudsman. The policyholder om- budsman can be reached at 415.778.7159 (phone), 415.371.5288 (fax) and [email protected] (emall).

B. California Department of Insurance - Information and Assistance. Information and assistance on be obtained the Department of Insurance Consumer HOTLINE 800.927.HELP (4357) or insurance.ca.gov. For questions and correspondence regarding appeals to the Administrative Hearing Bureau, see the contact information in paragraph II.C.

PN 04 99 02 B
(Ed. 05-02)

POLICYHOLDER NOTICE

CALIFORNIA WORKERS' COMPENSATION

INSURANCE RATING LAWS
Pursuant to Section 11752.8 of the California Insurance Code, we are providing you with an explanation of the California workers' compensation rating laws.

1. We establish our own rates for workers' compensation. Our rates, rating plans, and related information are filed with the insurance commissioner and are open for public inspection.

2. The insurance commissioner can disapprove our rates, rating plans, or classifications only if he or she has determined after public hearing that our rates might jeopardize our ability to pay claims or might create a monopoly in the market. A monopoly is defined by law as a market where one insurer writes 20% or more of that part of the California workers' compensation insurance that is not written by the State Compensation Insurance Fund. If the insurance commissioner disapproves our rates, rating plans, or classifications, he or she may order an increase in the rates applicable to outstanding policies.

3. Rating organizations may develop pure premium rates that are subject to the insurance commissioner's approval. A pure premium rate reflects the anticipated cost and expenses of claims per $100 of payroll for a given classification. Pure premium rates are advisory only, as we are not required to use the pure premium rates developed by any rating organization in establishing our own rates.

4. We must adhere to a single, uniform experience rating plan. If you are eligible for experience rating under the plan, we will be required to adjust your premium to reflect your claim history. A better claim history generaily results in a lower experience rating modification; more claims, or more expensive claims, generally result in a higher experience rating modification. The uniform experience rating plan, which is developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner.

5. A standard classification system, developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. The standard clas- sification system is a method of recognizing and separating policyholders into industry or occupational We can adopt and apply the standard clas-
sification system or develop and apply our own classification system, provided we can report the payroll, expenses, and other costs of claims in a way that is consistent with the uniform statistical plan or the standard classification system.

6. Our rates and classifications may not violate the Unruh Civil Rights Act or be unfairly discriminatory.

7. We will provide an appeal process for you to appeal the way we rate your insurance policy. The process requires us to respond to your written appeal within 30 days. If you are not satisfied with the result of your appeal, you may appeal our decision to the insurance commissioner.

California Workers' Compensation Insurance
Notice of Nonrenewal
Section 11664 of the California Insurance Code requires us, in most instances, to provide you with a notice of nonrenewal. Except as specified in paragraphs 1 through 6 below, if we elect to nonrenew your policy, we are required to deliver or mail to you a written notice stating the reason or reasons for the nonrenewal of the policy. The notice is required to be sent to you no earlier than 120 days before the end of the policy period and no later than 30 days before the end of the policy period. If we fail to provide you the required notice, we are required to continue the coverage under the policy with no change in the premium rate until 60 days after we provide you with the required notice.

Page 1 of 2 ends

We are not required to provide you with a notice of nonrenewal in any of the following situations:

1. Your policy was transferred or renewed without a change in its terms or conditions or the rate on which the premium is based to another insurer or other insurers who are members of the same insurance group as us.

2. The policy was extended for 90 days or less and the required notice was given prior to the extension.

3. You obtained replacement coverage or agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage.

4. The policy is for a period of no more than 60 days and you were notified at the time of issuance that it may not be renewed.

5. You requested a change in the terms or conditions or risks covered by the policy within 60 days prior to the end of the policy period
61298567 6. We made a written offer to you to renew the policy at a premium rate increase of less than 25 percent. (A) If the premium rate in your governing classification is to be increased 25 percent or greater and we intend to renew the policy, we shall provide a written notice of a renewal offer not less than 30 days prior to the policy renewal date. The governing ciassification shall be determined by the rules and regulations established in accordance with California Insurance Code Section 11750.3(c). 103518 (B) For purposes of this Notice, "premium rate" means the cost of insurance per unit of exposure prior to the application of individual risk variations based on loss or expense considerations such as scheduled rating and experience rating.

This notice does not change the policy to which it is attached

Page 2 of 2 ends

PN 04 99 04
(Ed. 12-01)

POLICYHOLDER NOTICE

CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA) SURCHARGE Companies writing property and casualty insurance business in California are required to participate in the California insurance Guarantee Association. If a company becomes insolvent, the California Insurance Guar- antee Association settles unpaid claims and assesses each insurance company for its fair share.

California law requires all companies to surcharge palicies to recover these assessments. If your policy is surcharged, "CA Surcharge" or "CA Surcharge (CIGA Surcharge)" with an amount will be displayed on your premium notice.

This notice does not change the policy to which it is attached 0* 54
SNW 04 08 07 18

POLICYHOLDER NOTICE
CALIFORNIA Assembly Bill (AB) 2883 and Senate Bill (SB) 189 Effective January 1, 2017
California AB 2883 revised allowable exemptions from the definition of an "employee" to only apply to:
• an officer or member of the board of directors, if he or she owns at least 15% of the issued and outstanding stock of the corporation;
• an individual who is a general partner of a partnership; and a managing member of a limited liability company
61298537 In order for an exemption to apply, a person must elect to be excluded by executing a written waiver of his or her rights under the laws governing workers' compensation, stating under penalty of perjury that he or she is a qualifying officer or director, or a qualifying general partner or managing member, as applicable.

This bill applied to all in force, new and renewing policies. 003518 Effective July 1, 2018
California SB 189 makes additional changes to the allowable exemptions, including:
• a person holding the power to revoke a trust with respect to share of a private corporation, general partnership or limited liability company, but only if the person meets the criteria described in Labor Code section 3352.;
• an officer or member of the board of directors, if either:
• heor she owns at least 10% of the issued and outstanding stock, or he or she owns at least 1% of the issued and outstanding stock of the corporation if his or her parent, grandparent, spouse or child owns at least 10% of the issued and outstanding stock and is covered by a health insurance policy • a general partner or managing member of a limited liability company; an owner of a professional corporation, who is rendering professional services for which the pro- fessional corporation is organized who is covered by a health care service plan or health insurance • an officer or member of the board of directors of a cooperative corporation who is covered by a health care service plan or health insurance policy, and a disability insurance policy that is com- parable in scope and coverage to a workers compensation policy; All of the employees mentioned above may be excluded by executing a written waiver of his or her rights under the laws governing workers' compensation, stating under penalty of perjury, that they are a quality- ing officer, director, general partner, or managing member. The insurer, with the consent of the employee executing the waiver, may elect to backdate the acceptance of the waiver up to 15 days prior to the date of receipt of the waiver.
=
In addition an officer or director of a private corporation who is the sole shareholder of the private corpora- tion is excluded from the definition of an employee, but may elect to be subject to workers compensation coverage.

Please contact your agent, broker or underwriter for additional information.

SNW 04 08 07 18 © 2018 Liberty Mutual Insurance Page 1 of 1 SNW 04 11 04 18
California Risk Control Services
Current California statutes reflect the desire of the legislature to promote safety and health in the workplace for all employees, and obligate workers' compensation insur- ers to provide risk control consultative services to their policyholders.

We want you to be informed about the services we offer. We provide our services based on the nature of your business, its size, hazards, and previous loss experience.

Our services are also available to you any time you request them.

California law requires you to assure a safe and healthful workplace for your employ- ees. In order to comply with the law you are required to follow those safety and health standards that apply to your business. While the burden of compliance rests with you, the employer, as does responsibility for implementing loss prevention programs, we are in a position to assist you.

Available risk control services are described below. There is no additional charge for these services.

1. Survey of Premises: We can conduct a survey to identify safety and health hazards and existing physical and management controls of those hazards.

When hazards are noted, we will provide you with written recommendations for improvement. Evaluation of your risk management program needs is included.

2. Accident Analysis: We can assist you through analysis of employee accidents and previous loss experience to identify underlying accident causes.

3. Industrial Hygiene Services: Preliminary surveys to identify physical and chemi- cal hazards in the workplace. We can assist you in the evaluation of personal protective equipment, administrative, and engineering controls for employee protection.

4. Noise Level Surveys: We can provide sound level surveys and, when needed, personal and area noise dosimetry studies to evaluate employee exposure to noise in the workplace.

5. Ergonomics Evaluation: We can provide assistance in the evaluation of workplace design as it relates to employee health and safety, and conduct ergonomic analysis of manual material handling and other tasks.

6. Training: We offer organized supervisory training programs for accident preven- tion and control. We can help you identify specific topics for training as well as identify your safety and health training needs and resources provided by our staff.

7. Safety and Health Program Development: We can assist you in developing a comprehensive safety and health program to help minimize workplace acci- dents, including implementation of appropriate elements of section 3203 Em- ployer Injury and Illness Prevention Program. Our programs are developed in accordance with California statutes and general safety practice, and are tai- lored to meet your specific needs.

SNW 04 11 04 18 @ 2018 Liberty Mutual Insurance Page 1 of 2 Policyholders may register comments about the insurer's risk control consultation services by writing to: State of California, Department of Industrial Relations, Division of Occupational Safety and Health, P.O. Box 420603, San Francisco, CA 94142.

Questions? Contact Risk Control Consulting Center Monday through Friday, 8 a.m. to 8 p.m. ET. Call us at 866-757-7324 or email [email protected]. rective measures. This report is based on information supplied by the customer and/or observations of conditions and practices. We have not tried to identify all hazards. We do not warrant that requirements of any federal, state, or local law, regulation or ordinance have or have not been met. This report does not create coverage. Only your policy or contract provides coverage subject to its terms, conditions, and exclusions. 003518
SNW 04 11 04 18 © 2018 Liberty Mutual Insurance Page 2 of 2 SNW 04 13 01 18

POLICYHOLDER NOTICE
CALIFORNIA SENATE BILL (SB) 1160 - MANAGED CARE NOTIFICATION Pursuant to California Labor Code Section 4610(g)(3)(B), this is to notify you that Liberty Mutual Managed Care LLC, which performs utilization review in the State of California, is a corporate affiliate of the following companies (and performs utilization review on their behalf:
• American Economy insurance Company
• American Fire and Casualty Company
• American States Insurance Company
• American States Insurance Company of Texas
• Employers Insurance Company of Wausau
• First National Insurance Company of America
General Insurance Company of America
• Golden Eagle Insurance Corporation
Helmsman Management Services LLC
• Liberty Insurance Corporation
Liberty Insurance Underwriters Inc.

Liberty Mutual Fire Insurance Company
Liberty Mutual Insurance Company
• Liberty Northwest Insurance Corporation
LM Insurance Corporation
LM Property and Casualty Insurance Company
Ohio Security Insurance Company
Peerless Indemnity Insurance Company
Peerless Insurance Company
Safeco Insurance Company of America
Safeco Insurance Company of Illinois
• San Diego Insurance Company
The First Liberty Insurance Corporation
The Netherlands Insurance Company
The Ohio Casualty Insurance Company
Wausau Business Insurance Company
• Wausau Underwriters Insurance Company
• West American Insurance Company
SNW 04 13 01 18 * 2018 Liberty Mutual Insurance Page 1 of 1

LIBERTY MUTUAL PRIVACY NOTICE - CALIFORNIA
(Workers' Compensation)
Effective January 1, 2020
Liberty Mutual Group, its affiliates and subsidiaries (collectively "Liberty Mutual" or "we", "us" and "our") provide workers' compensation insurance to companies. In this notice, we explain how we gather, use, share, and protect your data. This notice applies to you if you are a California resident and (i) are buying insurance for your company, (i) your company has workers' compensation insurance with us, or (ili) you have a workers' compensation claim. If this notice does not apply to you, please go to libertymutual.com/privacy to review our privacy notices for other states.

What Personal Data Do We Collect?
The types of personal data we gather and share depends on your relationship to us. For example, we may 51298563 he data we gather can include your social security number, services, or from other contacts with you. It may also include:
• Identifiers, including a real name, alias, postal address, unique personal identifier, online identifier, Internet Protocol address, email address, account name, Social Security Number, driver's license number, or other similar identifiers:
• Personal data, such as your name, signature, Social Security Number, physical characteristics or description, address, telephone number, drivers license or state identification ance policy number, education, employment, employment history, bank account number, financial data, medical data, or health insurance data;
• Protected classification characteristics described in California Civil Code 1798.80(e), including age, race, color, national origin, citizenship, religion or creed, marital status, medical physical or mental disability, sex (including gender, gender identity, gender expression, pregnancy or childbirth and related medical conditions), sexual orientation, veteran or military status; • Commercial data, including records of personal property, products or services purchased, ob- tained, or considered, or other purchasing or consuming histories and tendencies; • Internet or other similar network activity, including browsing history, search history. data on a consumer's interaction with a website, application, or advertisement; • Professional or employment related data, including current or past job history or performance evaluations;
• Inferences drawn from other personal data, such as a profile reflecting a person's preferences, characteristics, psychological trends, predispositions, behavior, attitudes, intelligence, abilities, and aptitudes;
Risk data, including data about your driving and/or accident history; this may include data from consumer reporting agencies, such as your motor vehicle records and loss history data, health data, or criminal convictions; and
• Claims data, including data about your previous and current claims, which may include data re- garding your health, criminal convictions, third party reports, or other personal data.

For data about the types of personal data we have gathered in the past tweive months, please go to libertymutual.com/privacy and click on the link for the California Supplemental Privacy Policy.

How do you gather my data?
We gather your personal data directly from you. We also gather your personal data from other For example, you provide us with data when you: people. For example:
• ask about, buy insurance or file a claim • your insurance agent or broker • pay your policy • your employer, association or business (if you are insured through them
SNW 04 14 01 20 © 2019 Liberty Mutual Insurance Page 1 of 5 • visit our websites, call us, or visit our office • our affiliates or other insurance companies about your transactions with them
• consumer reporting agencies, Motor Vehicle
Departments, and inspection services, to gather
your credit history, driving record, claims history,
or value and condition of your property
• other public directories and sources
• third parties, including other insurers, brokers
and insurance support organizations who you
have communicated with about your policy or
claim, anti- fraud databases, sanctions lists, court
judgments and other databases, goverment
agencies, open electoral register or in the event
of a claim, third parties including other parties to
the claim witnesses, expert loss adjustors and
claim handlers
• other third parties who take out a policy with us
and are required to provide your data such as
when you are named as a beneficiary or where a
family member has taken out a policy that re-
quires your personal data
Entities that share data with us may keep it and share it to others as permitted by law. For data about how we have gathered personal data in the past twelve months, please go to libertymutual.com/privacy and click on the link for the California Supplemental Privacy Policy.

How Do We Use Your Personal Data?
ay our do top and you in or produce and see and la roo
business purposes include:

Business Purpose Data Categories
Market, sell and provide insurance. This includes • Identifiers for example: • Personal Information
• calculating your premium; • Protected Classification Characteristics • determining your eligibility for a quote; • Commercial Information • confirming your identity and service your • Internet or other similar network activity policy; • Professional or employment related information • Inferences drawn from other personal
information
: Raidata Claims data
Manage your claim. This includes, for example: • Identifiers • managing your claim, if any; Personal Information
• conducting ciaims investigations; Protected Classification Characteristics • conducting medical examinations: Commercial Information • conducting inspections, appraisals; Internet or other similar network activity • providing roadside assistance; Professional or employment related information • providing rental car replacement, or repairs;
tion
SNW 04 14 01 20 ® 2019 Liberty Mutual Insurance Page 2 of 5 Risk data
• Claims data
Day to Day Business and Insurance Operations. • Identifiers This includes, for example: • Personal Information
• creating, maintaining, customizing and Protected Classification Characteristics securing accounts; • Commercial Information
• supporting day-to-day business and • Internet or other similar network activity insurance related functions; • Professionat or employment related information • doing internal research for technology • Inferences drawn from other personal • development; information
• marketing and creating products and • Risk data
services; • Claims data
• conducting audits related to a current contact
with a consumer and other transactions;
61208587
• as described at or before the point of
gathering personal data or with your
authorization;
Security and Fraud Detection. This includes for : Personass 003518 Personal information
example:
• detecting security issues; Protected Classification Characteristics • protecting against fraud or illegal activity, and Commercial Information to comply with regulatory and law •• Internet or other similar network activity enforcement authorities; • Professional or employment related information • managing risk and securing our systems, • Inferences drawn from other personal assets, infrastructure and premises; roadside information assistance, rental car replacement, or repairs Risk data •help to ensure the safety and security of : Rains data Liberty staff, assets and resources, which
may include physical and virtual access
controls and access rights management;
• supervisory controls and other monitoring and
reviews, as permitted by law; and emergency
and business continuity management;
Regulatory and Legal Requirements. This includes • Identifiers for example: • Personal Information
• controls and access rights management; Protected Classification Characteristics • to evaluate or conduct a merger, divestiture, Commercial Information restructuring, reorganization, dissolution, or • Internet or other similar network activity other sale or transfer of some or all of • Professional or employment related information • Liberty's assets, whether as a going concern • Inferences drawn from other personal or as part of bankruptcy, liquidation, or similar information proceeding, in which personal data held by Risk data
: Raids data
Liberty is among the assets transferred;
• exercising and defending our legal rights and
positions;
• to meet Liberty contract obligations;
• to respond to law enforcement requests and
as required by applicable law, court order, or
governmental regulations;
• as otherwise permitted by law
SNW 04 14 01 20 © 2019 Liberty Mutual Insurance Page 3 of 5 Improve Your Customer Experience and Our • Identifiers
Products. This includes for example: • Personal Information • improve your customer experience, our .. Commercial Information products and service; Internet or other similar network activity • to provide, support, personalize and develop Professional or employment related information our website, products and services; • Inferences drawn from other personal • create and offer new products and services; information • Risk data
• Claims data
Analytics to identify, understand and manage our • Identitiers risks and products. This includes for example: • Personal Information • conducting analytics to better identify. • Protected Classification Characteristics understand and manage risk and our •
products; • Internet or other similar network activity
Professional or employment related information
• Inferences drawn from other personal
information
• Risk data
• Claims data
Customer service and technical support. This • Identifiers includes for example: • Personal Information
• answer questions and provide notifications; Commercial Information • provide customer and technical support; • Internet or other similar network activity • Professional or employment related information
• Inferences drawn from other personal informa-
tion
• Risk data
• Claims data
Do We Share Your Personal Data?
Liberty Mutual does not sell your personal data as defined by California law.

Liberty Mutual may share personal data with affiliated and non-affiliated third parties, including:
• Liberty Mutual affiliates:

Service Providers (such as auto repair facilities, towing companies, property inspectors and in- dependent adjusters);
• Insurance support organizations;
• Brokers and agents;
Public entities (e.g. regulatory, quasi- regulatory, tax or other authorities, law enforcement agencies, courts, arbitrational bodies, and fraud prevention agencies); • Consumer reporting agencies;
Advisors including law firms, accountants, auditors and tax advisors; • Insurers, re-insurers, policy holders, and claimants; • Group policyholders (for reporting claims data or an audit; • Service providers and affiliates for actuarial or research studies; and • As permitted by law.

We may also share data with other companies that provide marketing services on our behalf or as part of a joint marketing agreement for products offered by Liberty Mutual. We will not share your personal data with others for their own marketing purposes.

We may also share data about our transactions (such as payment history) and experiences (such as claims made) with you to our affiliates.

SNW 04 14 01 20 @ 2019 Liberty Mutual Insurance Page 4 of 5 Liberty Mutual may share the following categories of personal data as needed for business purposes:

Identifiers Personal Data
Protected Classification Characteristics Commercial Data Internet or other similar network activity Professional, employment and education data Inferences drawn from personal data Risk Data
Claims Data
For data about how we have shared personal data in the past tweive months, please go to libertymutual.com/privacy and click on the link for the California Supplemental Privacy Policy.

How Do We Keep your Personal Data Safe?
We maintain physical, electronic, and administrative safeguards created to protect your data from unauthorized access. Our employees and agents are authorized to access your data only for legitimate business purposes.

What Rights Do I Have to Learn More About My Personal Data? 51298557 You may have rights under California laws to learn more about our privacy practices. For example, you may have the right to request a copy of certain information about you to review its completeness and accuracy.

You must make this request in writing by contacting us as indicated below.

You may have additional rights under other California laws. For more information about these rights, please go to libertymutual.com/privacy and click on the link California Supplemental Privacy Notice. If you cannot 033518 access the link, please contact us.

How to Contact Us:

You can submit requests, seek additional information, or obtain a copy of our privacy notice in an alter- native format by either:

Calling: 800-344-0197
Email: [email protected]
Online: Libertymutualgroup.com/privacy-palicy/data-request Mail: Attn: Privacy Office
Liberty Mutual Insurance Company
175 Berkeley St., Gth Floor
Boston, MA 02116
Who is Providing this Notice?
This privacy notice is provided on behalf of the following Liberty Mutual companies and affiliates:

America First Insurance Company, America First Lloyd's Insurance Company, American Economy Insur- ance Company, American Fire and Casualty Company, American States Insurance Company, American States Insurance Company of Texas, Colorado Casualty Insurance Company, Consolidated insurance Company, Employers Insurance Company of Wausau, Excelsior Insurance Company, First National Insur- ance Company of America, General Insurance Company of America, Golden Eagle Insurance Corpora- tion, Hawkeye-Security Insurance Company, Indiana Insurance Company, Liberty Insurance Corporation, Liberty Mutual Fire Insurance Company, Liberty Mutual Insurance Company, Liberty Mutual Mid-Atlant ic Insurance Company, Liberty Northwest Insurance Corporation, LM Insurance Corporation, Montgomery Mutual Insurance Company, North Pacific Insurance Company, Ohio Security Insurance Company, Or- egon Automobile Insurance Company, Peerless Indemnity Insurance Company, Peerless Insurance Com- pany, The First Liberty Insurance Corporation, The Midwestern Indemnity Company, The Netherlands Insurance Company, The Ohio Casualty Insurance Company, Wausau Business Insurance Company, Wausau General Insurance Company, Wausau Underwriters Insurance Company, and West American Insurance Company.

Liberty Ohio Security Insurance Company - a stock company XWS (21) 61 29 85 67 Mutual. Prior Policy Number.

INSURANCE
NCCI Go. No. 19291
Workers Compensation and
Employers Liability Insurance Policy
Information Page
ITEM 1: The Insured & Mailing Address Agent Mailing Address & Phone No.

FLYING LION, INC (812) 547-7901
2110 ARTESIA BLVD STE 234 HARPENAU INSURANCE, INC
REDONDO BEACH, CA 90278 PO BOX 7
TROY, IN 47588-0007
61298567
_Individual or Partnership
or_X Corporation or ULC or FEIN: 364809203 MAICS 524291 _LLP or Other Intra/Interstate Risk ID No.:

Other workplaces not shown above:

ITEM 2 The policy period is from 04/24/2020 to 04/24/2021 12:01 am Standard Timeat the insured' smailingaddress.

ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: CA
B. Employers Llability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A The limits of our liability under Part Two are Bodily Injury by Accident $1,000.000 each accident Bodily Injury by Disease $1,000,000 policy limit
Bodily Injury by Disease $1,000,000 each employee
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: See tension of information Pag
This policy includes these endorsements and schedules: See Policy Forms and Endorsements Summa ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Classifications Class icationsation required below is subject o vertica Premiuch Basis - Tutal. Rate per Estimated No. Estimated Annual $100 of Annual
Remuneration Remuneration Premlum
See Extension of Information Pages)
Total Estimated Annual Premium $4,385.00
Total Surcharges and Assessments $151.00
Minimum Premium $750.00 CA Total Estimated Cost $4,536.00 If indicated below, interim adjustments of premiums shall be made.

Deposit Premium $4,536.00
Servicing/Issuing Office North Area 13 - Indiana, Michigan Countersigned by:
and Issue Date 05/21/20
To report a claim, call your Agent or 1-844-325-2467
WC 00 00 01 A (WC 30 10 E) 1987 National Council on Compensation Insurance, Inc. 61298567 NO174551 360 PCAFPPNO INSURED COPY PAGE 23 OF
05/21/20
Coverage Is Provided In: I Policy Number:

Liberty Ohio Security Insurance Company - a stock company XWS (21) 61 29 85 67 Mutual. Policy Period:

INSURANCE From 04/24/2020 To 04/24/2021
NCCICo. No. [19291J Workers Compensation and allosured Maling dress Employers Liability Insurance Policy
Information Page
Named Insured Agent
FLYING LION, INC (812) 547-7901

HARPENAU INSURANCE, INC

EXTENSION OF INFORMATION PAGE
61298547

NAME AND LOCATION SCHEDULE
Named Insured CSN
001 FLYING LION, INC 001 Entity: CORPORATION FEIN: 364809203 003518
Countersigned by:

Issue Date 05/21/20
To report a claim, call your Agent or 1-844-325-2467
WC 99 06 81
05/21/20 61298567 N0174551 360 PCAFPPNO INSURED COPY 003518 PAGE 25 OF 54 Coverage Is Provided in: Policy Numbe
Liberty Ohio Security Insurance Company - a stock company WS (21) 61 29 85 67 Mutual. olicy Period
INSURANCE rom 04/24/2020 To 04/24/202
| From Frorsement Periodio
NCCICo. No. (19291
Workers Compensation and
Employers Liability Insurance Policy
Information Page
Named Insured Agent
FLYING LION, INC (812) 547-7901

HARPENAU INSURANCE, INC

EXTENSION OF INFORMATION PAGE
6129858
Name Link Code Location Description Exposure Record Link No. of Employees 00001 5 NAICS: 524291
001 2110 Artesia Bld Ste 234
003518 Redondo Beach, CA 90278-3073
Countersigned by: -
Issue Date 05/21/20
To report a claim, call your Agent or 1-844-325-2467
WC 99 06 82
INSURED COPY 8I9E00 PAGE 27 OF 54
05/21/20 61298567 N0174551 360 PCAFPPNO
Coverage is Provided in: Policy Number:

Liberty Ohio Security Insurance Company - a stock company... AWS (21) 61 29 85 67 Mutuál. Policy Period
INSURANCE -rom 04/24/2020 To 04/24/202
Endorsement Period:

From
NCCICo. No. 19291
Workers Compensation and al insure Maling dress
Employers Liability Insurance Policy
Information Page
Named Insured Agent
FLYING LION, INC (812) 547-7901

HARPENAU INSURANCE, INC

EXTENSION OF INFORMATION PAGE
61298561
ITEM 3 C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:

All states except North Dakota, Ohio, Washington, Wyoming and states designated in Item 3.A. on 003518 the Information Page.
=
Countersigned by:

Issue Date 05/21/20
To report a claim, call your Agent or 1-844-325-2467
WC 99 06 83
05/21/20 61298557 N0174551 360 PCAFPPNO AND 3A 003518 PAGE 29 OF 54 Coverage Is Provided in: Policy Numbe
Liberty Ohio Security Insurance Company - a stock company WS (21) 61 29 85 67 Mutual. Policy Period:

INSURANCE From 04/24/2020 To 04/24/202
Endorsement Period:

From To
NOCICo. No. 19291| 12:01 am Standard Time
Workers Compensation and at Insured' sMailingAddres
Employers Liability Insurance Policy
Information Page
Named Insured Agent
FLYING LION, INC (812) 547-7901

HARPENAU INSURANCE, INC
EXTENSION OF INFORMATION PAGE State: CALIFORNIA
6129856:

Classifications Code Premium Basis - Total Rate per Estimated No. Estimated Annual $100 of Annual
003518 Remuneration Remuneration Premium

FLYING LION, INC
2110 Artesia Bld Ste 234
Redondo Beach, CA 90278-3073
NEC 001 CSN 001 state 04 exp rec link 00001
Unmanned Aircraft System Operation - Aircraft System and Pay load Total Combined Weight of Less Than 55 Pounds - Includin g Outside Salespersons
8720 140,000.00 2.88 4,032.00
Total Subject Premium 4,032.00
Price Point Modification 9734 debit 1.034 137.00
Total Estimated Annual Standard Premium 4,169.00
WC Expense Constant 0900 160.00
Terrorism 9740 140,000.00 .03 42.00
Catastrophe (Other than Certified Acts of Terror.) 9741 140,000.00 .01 14.00 State Estimated Annual WC Premium 4,385.00
WC Administration Revolving Fund Assessment 0935 1.7040 75.00 Uninsured Employers Benefits Trust Fund Assessment 0937 - 1274 6.00 Subsequent Injuries Benefits Trust Fund Assessment 0938 -4829 21.00 Occupational Safety and Health Fund Assessment 0939 • 3918 17.00 Labor Enforcement and Compliance Fund Assessment 0992 •3813 17.00 9703 .3349 15.00
WC Fraud Account Assessment
CIGA Surcharge 0936 . 0000 - 00
4,536.00
CA Total Cost
Countersigned by:

Issue Date 05/21/20
To report a claim, call your Agent or 1-844-325-2467
WC 99 06 84
05/21/20 61298567 N0174551 360 PCAFPPNO INSURED COPY 003518 PAGE 31 OF 54 Coverage Is Provided in:

Liberty Ohio Security Insurance Company. - a stock company Mutuál. olicy Period
rom 04/24/2020 To 04/24/202

INSURANCE
From Frorsement Period o
NCCI Co. No. 19291 i insure aling dress
Workers Compensation and
Employers Liability Insurance Policy
Information Page
Named Insured Agent
FLYING LION, INC (812) 547-7901

HARPENAU INSURANCE, INC

EXTENSION OF INFORMATION PAGE
6179856

POLICY FORMS AND ENDORSEMENTS
03518 This section lists all the Forms and Endorsements that make up your policy. Refer to these documents as needed for detailed information concerning your coverage.

STATE(S) Applicable

FORM NUMBER TITLE
WC 00 04 22 B Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement CA WC 04 03 01 D Policy Amendatory Endorsement - California CA WC 04 03 10 Duty To Defend Endorsement - California CA
WC 04 03 60 B Employers' Liability Coverage Amendatory Endorsement - California CA WC 04 04 21 Optional Premium Increase Endorsement - California CA WC 04 06 01 A California Cancellation Endorsement CA
Notification Endorsement Of Pending Law Change To Terrorism Risk Insurance CA WC 99 21 34
Program Reauthorization Act Of 2015
Countersigned by:

Issue Date 05/21/20
To report a claim, call your Agent or 1-844-325-2467
WC 99 06 85
PCAFPPNO INSURED COPY 003518 PAGE 33 OF 54
05/21/20 61298567 NO174551 360
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C

THE OHIO CASUALTY INSURANCE COMPANY

OHIO SECURITY INSURANCE COMPANY

AMERICAN FIRE AND CASUALTY COMPANY
Home Offices
175 Berkeley St., Boston, MA 02116
Stock Companies domiciled in New Hampshire

WEST AMERICAN INSURANCE COMPANY
Home Office
61298557 175 Berkeley St., Boston, MA 02116
Stock Company domiciled in Indiana

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 003518

QUICK REFERENCE

BEGINNING ON
Page
General Section 3
3 A. The Policy
B. Who is Insured
C. Workers Compensation Law 3
3 D. State ...
3 E. Locations
3 PART ONE - WORKERS COMPENSATION INSURANCE...

A. How This Insurance Applies
3 B. We Will Pay....

We Will Defend 3
C.

D. We Will Also Pay 3
E. Other Insurance
F. Payments You Must Make
G. Recovery From Others
H. Statutory Provisions .

PART TWO - EMPLOYERS LIABILITY INSURANCE
A. How This Insurance Applies
5 B. We Will Pay..
5 C. Exclusions
6 D. We Will Defend.
6 E. We Will Also Pay
F. Other Insurance 6
WC 00 00 00 C (01-15) © 2013 Liberty Mutual Insurance WC 99 50 04 Contains copyrighted materials of the National Council on Page 1 of 9 Compensation Insurance, Inc., used with its permission.

WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

QUICK REFERENCE - CONTINUED

BEGINNING ON
Page
G. Limits of Liability 6
H. Recovery From Others 6
I. Actions Against Us. 6
PART THREE - OTHER STATES INSURANCE ... 7
A. How This Insurance Applies 7
B. Notice 7
PART FOUR - YOUR DUTIES IF INJURY OCCURS 7
PART FIVE - PREMIUM 7
A. Our Manuals ....7
B. Classifications .7
C. Remuneration .7
D. Premium Payments 7
E. Final Premium •• 8
F. Records 8
G. Audit 8
PART SIX - CONDITIONS 8
A. Inspection 8

8. Long Term Policy 8
C. Transfer of Your Rights and Duties 8
D. Cancellation 8
E. Sole Representative 9
IMPORTANT: This Quick Reference is not part of the Workers Compensation and Employers Liability Policy and does not provide coverage. Refer to the Workers Compensation and Employ- ers Liability Policy itself for actual contractual provisions.

PLEASE READ THE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY CAREFULLY.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows:

GENERAL SECTION
A. The Policy
This policy includes at its effective date the Information Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Information Page) and us (the insurer named on the Information
this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy.

B Who Is Insured
You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a A1209567 partnership. and if you are one of its partners, you are insured, but only in your capacity as an employer of the partnership's employees.

C. Workers Compensation Law
Workers Compensation Law means the workers or workmen's compensation law and occupational disease 10351R
compensation law, any federal
nonoccupational disability benefits.

D. State
State means any state of the United States of America, and the District of Cotumbia.

E. Locations
This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self-insured for such workplaces.

PART ONE

WORKERS COMPENSATION INSURANCE
A. How This Insurance Applies
This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death.

1. Bodily injury by accident must occur during the policy period.

2. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period.

B. We Will Pay
0° 54 We will pay promptly when due the benefits required of you by the workers compensation law.

C. We Will Defend
We have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to investigate and settle these claims, proceedings or suits.

We have no duty to defend a claim, proceeding or suit that is not covered by this insurance.

D. We Will Also Pay
We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend:

1. reasonable expenses incurred at our request, but not loss of earnings;

2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance;

3. litigation costs taxed against you;

4. interest on a judgment as required by law until we offer the amount due under this insurance; and WC 00 00 00 C (01-15) © 2013 Liberty Mutual Insurance WC 99 50 04 Contains copyrighted materials of the National Council on Page 3 of 9 Compensation Insurance, Inc., used with its permission.

WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

5. expenses we incur.

E. Other Insurance
We will not pay more than our share of benefits and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid.

If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid.

F. Payments You Must Make
You are responsible for any payments in excess of the benefits regularly provided by the workers com- pensation law including those required because:

1. of your serious and willful misconduct;

2. you knowingly employ an employee in violation of law;

3. you fail to comply with a health or safety law or regulation; or

4. you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law.

If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly.

G. Recovery From Others
We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them.

H. Statutory Provisions
These statements apply where they are required by law.

1. As between an injured worker and us, we have notice of the injury when you have notice.

2. Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury occurs.

3. We are directly and primarily liable to any person entitled to the benefits payable by this insurance.

Those enforce our duties; so may an agency authorized by law. Enforcement may be against us or against you and us

4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law.

5. This insurance conforms to the parts of the workers compensation law that apply to:
a. benefits payable by this insurance;
specia, taxes, payments into security or other special funds, and assessments payable by us under that law.

6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law.

Nothing in these paragraphs relieves you of your duties under this policy.

PART TWO

EMPLOYERS LIABILITY INSURANCE
A. How This Insurance Applies
This employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death.

1. The bodily injury must arise out of and in the course of the injured employee's employment by you

2. The employment must be necessary or incidental to your work in a state or territory listed in Item 3.A. of the Information Page.

Bodily injury by accident must occur during the policy period.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C

4. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period.

5. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada.

B. We Will Pay
Ne will pay all sums that you legally must pay as damages because of bodily injury to your employees rovided the bodily injury is covered by this Employers Liability Insurance The damages we will pay, where recovery is permitted by law, include damages:

1. For which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed against such third party as a result of injury to your employee;

2. For care and loss of services; and
61208557 For consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee;

3. provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and

4. Because of bodily injury to your employee that arises out of and in the course of employment, claimed 003518 against you in a capacity other than as employer.

C. Exclusions
This insurance does not cover:

1. Liability assumed under a contract. This exclusion does not apply to a warranty that your work will be done in a workmanlike manner;

2. Punitive or exemplary damages because of bodily injury to an employee employed in violation of law:

3. Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive officers;

4. Any obligation imposed by a workers compensation, occupational disease, unemployment compensa- tion, or disability benefits law, or any similar law;

5. Bodily injury intentionally caused or aggravated by you;

6. Bodily injury occurring outside the United States of America, its territories or possession s, and Canada.

This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries;

7. Damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, or any personnel practices, policies, acts or omissions;

8. Bodily injury to any person in work subject to the Longshore and Harbor Workers' Compensation Act (33 U.S.C. Sections 901 et seg.), the Nonappropriated Fund Instrumentalities Act (5 U.S.C. Sections 8171 et seq.), the Outer Continental Shelf Lands Act (43 U.S.C. Sections 1331 et seq.), the Defense Base Act (42 U.S.C. Sections 1651-1654), the Federal Mine Safety and Health Act (30 U.S.C. Sections 801 et seq. and 901-944), any other federal workers or workmen's compensation law or other federal occupa- tional disease law, or any amendments to these laws;

9. et seq.), any other federal laws obligating an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amendments to those laws;

10. Bodily injury to a master or member of the crew of any vessel, and does not cover punitive damages related to your duty or obligation to provide transportation, wages, maintenance, and cure under any applicable maritime law;

11. Fines or penalties imposed for violation of federal or state law; and

12. Damages payable under the Migrant and Seasonal Agricultural Worker Protection Act (29 U.S.C. Sec- tions 1801 et seq.) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws.

WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY D. We Will Defend
We have the right and duty to defend, at our expense, any claim, proceeding or suit against you for damages payable by this insurance. We have the right to investigate and settle these claims, proceedings and suits.

We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance.

E. We Will Also Pay
We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend;

1. Reasonable expenses incurred at our request, but not loss of earnings;

2. Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance;

3. Litigation costs taxed against you;

4. Interest on a judgment as required by law until we offer the amount due under this insurance; and

5. Expenses we incur.

F. Other Insurance
We will not pay more than our share of damages and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance and self-insurance will be equal until the loss is paid
G. Limits of Liability
Our liability to pay for damages is limited. Our limits of liability are shown in Item 3.B. of the Information Page. They apply as explained below.

1. Bodily Injury by Accident. The limit shown for "bodily injury by accident-each accident" is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident.

A disease is not bodily injury by accident unless it results directly from bodily injury by accident.

2. Bodily Injury by Disease. The limit shown for "bodily injury by disease-policy limit" is the most we will pay for all damages covered by this insurance and arising out of bodily injury by disease, regardless of the number of employees who sustain bodily injury by disease. The limit shown for "bodily injury by disease-each employee" is the most we will pay for all damages because of bodily injury by disease to any one employee.

Bodily injury by disease does not incide disease that results directly from a bodily injury by accident.

3. We will not pay any claims for damages after we have paid the applicable limit of our liability under this insurance.

H. Recovery From Others

1. Actions Against Us
There will be no right of action against us under this insurance unless:

1. You have complied with all the terms of this policy; and

2. The amount you owe has been determined with our consent or by actual trial and final judgment.

This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability. The bankruptcy or insolvency of you or your estate will not relieve us of our obligations under this Part.

WC 00 00 00 C (01-15) @ 2013 Liberty Mutual Insurance WC 99 50 04 Contains copyrighted materials of the National Council on Page 6 of 9 Compensation Insurance. Inc., used with its permission.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C

PART THREE

OTHER STATES INSURANCE
A. How This Insurance Applies

1. This other states insurance applies only if one or more states are shown in Item 3.C. of the Information

2. If you begin wark in any one of those states after the effective date of this policy and are not insured or are not seif-insured for such work, all provisions of the policy will apply as though that state were listed in Item 3.A. of the Information Page.

3. We will reimburse you for the benefits required by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them.

4. If you have work on the effective date of this policy in any state not listed in Item 3.A. of the Information Page, coverage will not be afforded for that state unless we are notified within thirty days. 61298567 B. Notice
Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page.

PART FOUR

YOUR DUTIES IF INJURY OCCURS
002518 Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here.

1. Provide for immediate medical and other services required by the workers compensation law.

2. Give us or our agent the names and addresses of the injured persons and of witnesses, and other information we may need.

3. Promptly give us all notices, demands and legal papers related to the injury, claim, proceeding or suit.

4. Cooperate with us and assist us, as we may request, in the investigation, claim, proceeding or suit.

5. Do nothing after an injury occurs that would interfere with our right to recover from others.

6. Do not voluntarily make payments, assume obligations or incur expenses, except at your own cost.

PART FIVE

PREMIUM
A. Our Manuals
All premium for this policy will be determined by our manuals of rules, rates, rating pians and classifica- tions. We may change our manuals and apply the changes to this policy if authorized by law or a gov- emmental agency regulating this insurance.

B. Classifications
Item 4 of the Information Page shows the rate and premium basis for certain business or work classifica- tions. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classifications, rates and premium basis by endorsement to this policy.

C. Remuneration
remium for each work classification is determined by multiplying a rate times a premium basis. Remunera tion is he most common premium basis. This premium basis includes payroll and all other remuneratior paid or payable during the policy period for the services of:

1. all your officers and employees engaged in work covered by this policy; and

2. all other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligation s.

D. Premium Payments
You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid
WC 00 00 00 C (01-15) © 2013 Liberty Mutual Insurance WC 99 50 04 Contains copyrighted materials of the National Council on Page 7 of 9 Compensation Insurance, Inc., used with its permission.

WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY E. Final Premium
The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy.

If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy.

If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise:

1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium.

2. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short-rate cancelation table and procedure. Final premium will not be less than the minimum premium.

F. Records
You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them.

G. Audit
journals, registers,
and within three years after the policy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision.

PART SIX

CONDITIONS
A. Inspection
We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insurance rate service organizations have the same rights we have under this provision.

B. Long Term Policy
If the policy period is longer than one year and sixteen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force.

C. Transfer of Your Rights and Duties
Your rights or duties under this policy may not be transferred without our written consent.

As insure and we receive notice within thirty days after your death, we will cover your legal representative D. Cancelation

1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect.

2. We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice.

The policy period will end on the day and hour stated in the cancelation notice.

4. Any of these provisions that conflict with a law that controls the cancelation of the insurance in this policy is changed by this statement to comply with the law.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C E. Sole Representative
The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation.

In witness whereof, we have caused this policy to be signed by our authorized officers.

SECRETARY PRESIDENT
61298567
003518
WC 00 00 00 C (01-15) © 2013 Liberty Mutual Insurance WC 99 50 04 Contains copyrighted materials of the National Council on Page 9 of 9 Compensation Insurance, Inc., used with its permission.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 B (Ed. 1-15)

TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2015. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism.

Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations.

Definitions
The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply.
"Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2015.
"Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States as meeting all of the following requirements:
a. The act is an act of terrorism.
b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion.
"Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvan ia, including an act of war,
States missions or to certain air carriers or vessels.
"Insurer Deductible" means, for the period beginning on January 1, 2015, and ending on December 31, 2020, an amount equal to 20% of our direct earned premiums, during the immediately preceding calendar year.

Limitation of Liability
The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up ta $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury.

Policyholder Disclosure Notice

1. insured Losses would be partially reimbursed by the United States Government. If the aggregate in- dustry Insured Losses exceed:
a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the United States Government would pay 85% of our Insured Losses that exceed our Insurer Deductible. b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the United States Government would pay 84% of our Insured Losses that exceed our Insurer Deductible.

WC 00 04 22 B
(Ed. 1-15)

Page 1 of 2 ends

WC 00 04 22 B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1-15)
$140,000,000, with respect to such Insured Losses occurring in calendar year 2017, the United States Government would pay 83% of our Insured Losses that exceed our Insurer Deductible. d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the United States Government would pay 82% of our Insured Losses that exceed our Insurer Deductible. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the United States Government would pay 81% of our Insured Losses that exceed our Insurer Deductible. $200,000,000, with respect to such Insured Losses occurring in calendar year 2020, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible.

2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 61298567 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below.

Schedule
303518 State Rate Premium
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Endorsement No. 0001
Policy Effective 04/24/2020 Premium
State
Policy No. XWS (21) 61 29 85 67
Insured FLYING LION, INC
Insurance Company Ohio Security Insurance Company 19291 Countersigned by
WC 00 04 22 B
(Ed. 1-15)

Page 2 of 2 ends

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 01 D (Ed. 02-18)

POLICY AMENDATORY ENDORSEMENT-CALIFORNIA
It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions:

1. Minors Illegally Employed - Not Insured. This policy does not cover liability for additional compensa- tion imposed on you under Section 4557, Division IV, Labor Code of the State of California, by reason of injury to an employee under sixteen years of age and illegally employed at the time of injury.

2. Punitive or Exemplary Damages - Uninsurable. This policy does not cover punitive or exemplary dam- ages where insurance of liability therefor is prohibited by law or contrary to public policy.

3. Increase in Indemnity Payment - Reimbursement. You are obligated to reimburse us for the amount of increase in indemnity payments made pursuant to Subdivision (d) of Section 4650 of the California Labor Code, if the late indemnity payment which gives rise to the increase in the amount of payment is due less than seven (7) days after we receive the completed claim form from you. You are obligated to reimburse us for any increase in indemnity payments not covered under this policy and will reimburse us for any increase in indemnity payment not covered under the policy when the aggregate total amount of the reimbursement payments paid in a policy year exceeds one hundred dollars ($100).

If we notify you in writing, within 30 days of the payment, that you are obligated to reimburse us, we will bill you for the amount of increase in indemnity payment and collect it no later than the final audit.

You will have 60 days, following notice of the obligation to reimburse, to appeal the decision of the insurer to the Department of Insurance.

4. Application of Policy. Part One, "Workers Compensation Insurance", A, "How This Insurance Applies", is amended to read as follows:

This workers compensation insurance applies to bodily injury by accident or disease, including death resulting therefrom. Bodily injury by accident must occur during the policy period. Bodily injury by disease must be caused or aggravated by the conditions of your employment. Your employee's expo- sure to those conditions causing or aggravating such bodily injury by disease must occur during the policy period

5. Rate Changes. The premium and rates with respect to the insurance provided by this policy by reason of the designation of California in Item 3 of the Information Page are subject to change if ordered by the Insurance Commissioner of the State of California pursuant to Section 11737 of the California insurance Code.

6. Long Term Policy. If this policy is written for a period longer than one year, all the provisions of this policy shall apply separately to each consecutive twelve-month period or, if the first or last consecutive period is less than twelve months, to such period of less than twelve months, in the same manner as if a enor to policy a be mite to sc for each consecutive period.

7. Statutory Provision. Your employee has a first lien upon any amount which becomes owing to you by us on account of this policy, and in the case of your legal incapacity or inability to receive the money and pay it to the claimant, we will pay it directly to the claimant.

8. Part Five, "Premium", E, "Final Premium", is amended to read as follows:
on the Information Page, schedules, and endorsements is an estimate. The fina basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy.

WC 04 03 01 D
(Ed. 02-18) Page 1 of 2
© 2016 Workers Compensation Insurance Rating Bureau of California. All rights reserved WC 04 03 01 D WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 02-18)
If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise:
a. If we cancel, final premium will be calculated pro rata based on the time this policy was in force.

Final premium will not be less than the pro rata share of the minimum premium. •. it you ea and may permir may be use tate rana, in bale sad or the in. Fral premium will not be less than the pro rata share of the minimum premium.

It is further agreed that this policy, including all endorsements forming a part thereof, constitutes the entire contract of insurance. No condition, provision, agreement, or understanding not set forth in this policy or such endorsements shall affect such contract or any rights, duties, or privileges arising therefrom. 61298567
003518
Issued by Ohio Security Insurance Company 19291
For attachment to Policy No. XWS (21) 61 29 85 67 Effective Date Premium $ Issued to FLYING LION, INC
WC 04 03 01 D
(Ed. 02-18) Page 2 of 2
© 2016 Workers Compensation Insurance Rating Bureau of California. All rights reserved WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 10 (Ed. 01-95)

DUTY TO DEFEND - CALIFORNIA
The insurance afforded by Part One, Section C, "We Will Defend", is hereby deleted and replaced with the following:

WE WILL DEFEND
We have the right and duty to defend at our expense any claim or proceeding against you before the California Workers' Compensation Appeals Board or its equivalent in any other state (and any appeal of a decision therefrom for the benefits payable by this workers' compensation insurance. We have the right to investigate and settle these claims or proceedings.

We have no duty to defend a claim, proceeding, or suit that is not covered by this insurance.

Nothing contained in this Section shall amend, modify, restrict, or otherwise alter any obligations ar condi- tions under Part Two - Employer's Liability insurance of the policy.

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Endorsement No. 0003
Policy Effective 04/24/2020 Premium
State
Policy No. XWS (21) 61 29 85 67
Insured FLYING LION, ING
Insurance Company Ohio Security Insurance Company 19291 Countersigned by ...

EMPLOYERS' LIABILITY COVERAGE AMENDATORY ENDORSEMENT - CALIFORNIA The insurance afforded by Part Two (Employers' Liability Insurance) by reason of designation of California in item 3 of the information page is subject to the following provisions:

A. "How This Insurance Applies," is amended to read as follows:

A. How This Insurance Applies
This employers' liability insurance applies to bodily injury by accident or bodily injury by disease.

Bodily injury means a physical injury, including resulting death.

1. The bodily injury must arise out of and in the course of the injured employee's employment by you.
61298567 2. The employment must be necessary or incidental to your work in California.

3. Bodily injury by accident must occur during the policy period.

4. Bodily injury by disease must be caused or aggravated by the conditions of your employment.

The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period.

C. The "Exclusions" section is modified as follows (all other exclusions in the "Exclusions" section remain as is):

1. Exclusion 1 is amended to read as follows:

1. liability assumed under a contract.

2. Exclusion 2 is deleted
Exclusion 7 is amended to read as follows:

7. damages arising out of coercion, criticism, demation, evatuation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any em- ployee, termination of employment, or any personnel practices, policies, acts or omis- sions.

4. The following exclusions are added:

1. bodily injury to any member of the flying crew of any aircraft

2. bodily injury to an employee when you are deprived of statutory or common law defenses or are subject to penalty because of your failure to secure your obligations under the workers compensation laws) applicable to you or otherwise fail to comply with that law.

3. liability arising from California Labor Code Section 2810.3 which relates to labor con- tracting.

WC 04 03 60 B
(Ed. 01-15)
© 2014 Workers Compensation Insurance Rating Bureau of California. All rights reserved WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 60 B (Ed. 01-15)
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Endorsement No. 0004
Policy Effective 04/24/2020 Premium
State
Policy No. XWS (21) 61 29 85 67
Insured FLYING LION, INC
Insurance Company Ohio Security Insurance Company 19291 Countersigned by
WC 04 03 60 B
(Ed. 01-15)
® 2014 Workers' Compensation Insurance Rating Bureau of Califoria. All rights reserved.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 04 21 (Ed. 01-08)

OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA
You must provide us, or our authorized representative, access to records necessary to perform a payroll verification audit. If you fail to provide access within 90 days after expiration of the policy, you are liable to pay a total premium equal to 3 times our current estimate of the annual premium for your policy. In addition, if you fail to provide access after our third request within a 90 day or longer period, you are also liable for our costs in attempting to perform the audit unless you provide a compelling business reason for your failure.

We will contact you to schedule appointments during normal business hours.

We will notify you of your failure to provide access by mailing a certified, return-receipt document stating 61298567 the increased premium and the total amount of our costs incurred in our attempts) to perform an audit. In addition to any other obligations under this contract, 30 days after you receive the notification, you will be obligated to pay the total premium and costs referenced above. If, thereafter, you provide access to your records within three years after the policy expires, or within another mutually agreed upon time, and we succeed in performing the audit to our satisfaction, we will revise your total premium and the costs due to 033518 reflect the results of the audit.

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Endorsement No. 0005
Policy Effective 04/24/2020 Premium
State
Policy No. XWS (21) 61 29 85 67
Insured FLYING LION, INC
Insurance Company Ohio Security Insurance Company 19291 Countersigned by
WC 04 04 21
(Ed. 01-08)
© 2008 Workers Compensation Insurance Rating Bureau of California. All rights reserved.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 A (Ed. 12-93)

CALIFORNIA CANCELATION ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because California is shown in Item

3.A. of the Information Page.

The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions:

Cancelation:

1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect.

2. We may cancel this policy for one or more of the following reasons:
a. Non-payment of premium;
b. Failure to report payroll;
c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us:
d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us;
e. Material misrepresentation made by you or your agent; f. Failure to cooperate with us in the investigation of a claim; g. Failure to comply with Federal or State safety orders; h. Failure to comply with written recommendations of our designated loss control representatives :
i. The occurrence of a material change in the ownership of your business; j. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss;
K. The occurrence of any change in your business or operation that requires additional or different classification for premium calculation;

1. The occurrence of any change in your business or operation which contemplates an activity ex- cluded by our reinsurance treaties.

3. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items (g) through (I), we will give you 30 days advance written notice; however, we agree that in the event of canceiation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided.

4. The policy period will end on the day and hour stated in the cancelation notice.

WC 04 06 01 A
(Ed. 12-93)
© 1993 Workers Compensation Insurance Rating Bureau of California. All rights reserved WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 A (Ed. 12-93)
61298507
003518
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Endorsement No. 0006
Policy Effective 04/24/2020 Premium
State
Policy No. XWS (21) 61 29 85 67
Insured FLYING LION, INC
Insurance Company Ohio Security Insurance Company 19291 Countersigned by
WC 04 06 01 A
(Ed. 12-93)
© 1993 Workers Compensation Insurance Rating Bureau of California. All rights reserved.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 21 34 (Ed. 1-20)

NOTIFICATION ENDORSEMENT OF PENDING LAW CHANGE TO TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015
This endorsement is being attached to your workers compensation and employers liability insurance policy.

This endorsement does not replace the separate Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 B) that is attached to your current policy and which remains in effect as applicable.

The Terrorism Risk Insurance Act of 2002 (TRIA), as previously amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2015 (TRIPRA 2015), provides for a program under which the federal government will share in the payment of insured losses caused by certain acts of terrorism. In the absence of affirmative US Congressional action to extend, update, or otherwise reauthorize TRIPRA 2015, in whole or in part, TRIPRA 2015 is scheduled to expire on December 31, 2020.

Since the timetable for any further Congressional action regarding TRIPRA 2015 is presently unknown, and exposure to acts of terrorism remains, we are providing policyholders with relevant information concerning their workers compensation policies in the event of the TRIPRA 2015's expiration.

Your policy provides coverage for workers compensation losses caused by acts of terrorism, including workers compensation benefit obligations dictated by state law, except in Pennsylvania, where injuries or deaths resulting from certain war-related activities are excluded from workers compensation coverage.

Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy.

The premium charge for the coverage that your policy provides for terrorism losses is shown in Item 4 of the policy Information Page or the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 B) Schedule that is attached to your policy. This amount may continue or change for new, renewal, and in-force policies in effect on or after December 31, 2020, in the event of TRIPRA 2015's expiration, subject to regulatory review in accordance with applicable state law.

You need not do anything further at this time.

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Issued by Ohio Security Insurance Company 19291
For attachment to Policy No. XWS (21) 61 29 85 67 Effective Date Premium s Issued to FLYING LION, INC Endorsement No.

WC 99 21 34 ©2018 Liberty Mutual Insurance Page 1 of 1
Ed. 01/01/2020 Contains copyrighted materials of National Council on Compensation Insurance, Inc., used with its permission.

Redondo Beach City CouncilJanuary 17, 2023

Redondo Beach City Council
January 17, 2023